What have you been reading, hearing or TV viewing that has provoked some feelings of comfort or concern about what is happening in the world of medicine, medical care, treatment or science? Ethics is all about doing the right thing. Are you aware of any issues in medicine or biologic science which are being done right, could be improved or in fact represent totally unethical behavior?
Write about them here.. and I will too! ..Maurice (DoktorMo@aol.com)

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Tuesday, August 02, 2005

"Bringing Out the Dead" in One Way or Another

I would like to bring to the attention of my visitors a new publication. It is ATRIUM- The Report of the Northwestern Medical Humanities and Bioethics Program of Northwestern University Feinberg School of Medicine. The title of this first issue is “Bringing Out the Dead”. Amongst other considerations, the ethics of the use and display of the dead is discussed. There are articles presenting the two views of whether specimens of the dead fetuses representing developmental anomalies should be displayed in a museum-type setting. There is an article dealing with the “Body Worlds Exhibit” which is a public display of human corpses which have been preserved in plastic “appearing in naturalistic, non-clinical settings and pose with their skin removed, revealing the inner dimensions of the body to the museum goer.”

An article, to which I was most interested dealt with the medical school teaching of human anatomy either by the longstanding practice of student dissection of the dead body versus the relatively new teaching of anatomy only by prosections: students looking and studying anatomical specimen which had been previously professionally dissected out by their anatomy teacher. With prosections, the medical student will not be faced with a whole human corpse and will not spend hours cutting through fat and muscle to find or follow an anatomical structure. It will all be there clearly defined in the prosected specimen. The student will save time, save frustration and save much of the odor of formaldehyde permeating the nasal passages. But will the student miss something? Would there be some value for the students to actually be introduced to their “first patient” on the anatomy table? To recognize that their “patient” was once a live human being with all the capacity for feelings and anticipation of the future which the students themselves hold. And that the students, as humans, are no different than their subject except they are still alive. Would it provide them with a special experience to emphasize, from the beginning of their careers, that all human beings deserve respect including the deceased and the disabled?

Apparently, there are both advantages and disadvantages for medical schools to teach by prosection. It would be important to know what differences in knowledge or skills have been observed in students who learn anatomy by prosection alone as compared with personal dissection. Of interest would be studies to establish whether the absence of this “first patient” in year one anatomy makes any difference in the clinical relationships with the later live patients.

Have any of my visitors had their own human anatomy education in medical school solely by prosection? I would like to know what it was like and if the lack of dissection experience makes them feel now like they are not a “real doctor”. ..Maurice.

3 Comments:

I attended the Body Worlds Exhibit when it was in Los Angeles and found it quite interesting. It was so amazing for so many people to have the opportunity to see bodies in such detail. Most of them would otherwise never have seen a dissected body.

Not that long ago, people slaughtered and prepared their meat products themselves. They would have been quite conscious of the anatomy of many animals and would have noticed the similarities between species. They would have been aware of the anatomical similarities to humans - even if they had never dissected a human. Today, I think that very few people are aware of the locations of their major organs. Body Worlds provides an interesting educational option to those who are curious to know more.

As someone who wishes to become a doctor, I am somewhat scared that the dissection of human bodies will disappear from medical education. I thought of many reasons why I feel this way and the one that seems to apply to formaldehyde preserved bodies (versus plastinated ones) is that gross anatomy is an opportunity to perform your first surgery on someone you cannot kill. Certainly, when I stand in front of the body in my gross anatomy class, I will look at him/her and think, “I have no idea what I’m doing.” How hard should I push my scalpel when I am cutting open the abdomen? What if I slice open something I'm not supposed to? These concerns would not disappear just because I "operate" on a dead person. However, I really don't want my first major cut to be on someone whose family is depending on a surgical cure (from someone with experience). I don't anticipate that there will be many "health volunteers" lining up to participate in medical educational surgery.

Alyssa, standing in front of that human body on the first day of medical school is truely a humbling experience in so many ways. And so is the cutting, squeezing, pulling and finally tearing the tissues and then not find the anatomic structure you were instructed to find. It's humbling allright! I think that if you don't start your medical career being humble, will you may ever be once you gain all your medical skills? Not all doctors are humble as they face the fact that a patient died under their care. There is always some excuse beyond ones own responsibilities that can be projected upon the patient or the patient's disease. Sure it's cleaner, faster and more time-wise efficient in learning human anatomy to use prosected specimens. But I think that the medical student learning solely from the blocks of plastic or a lump of tissue dissected from the body by a professional miss something. There is some value, I think, in at least starting out with humility. ..Maurice.

As a medical student who also attended the Body Worlds exhibit in Los Angeles, I wanted to share my thoughts on the subject. At my medical school, we learn gross anatomy through hands-on dissection. And yes, I must agree that it is a very humbling experience. Many times during the course, I thought of the man whose body I had privilege of learning from. Sometimes I caught myself not giving the proper respect, and then feeling very disappointed with myself for not being more grateful. Other times I thought about what he was like, what his family had been, and who he was. I thought of my own grandparents, and realized that this could have been any one of them, and that this was, in fact, someone else’s grandpa. I am very grateful to people with the courage and dedication to give their last earthly possession to someone else, purely for their learning.

I cannot imagine learning anatomy through pro-section only. I agree totally that the humbling experience of reality is an essential learning moment. I also think that it would be difficult to appreciate fully what the human body is if you have not touched and felt your way through it. Learning with one sense only could not be nearly as effective as with multiple senses involved. Going beyond the pro-sections, I wonder how some schools teach anatomy on computer only. I think that that is unfortunate, to say the least.

My main impression of Body Worlds was that I wish everyone could see it. I wanted my family to come and experience it, as well as everyone I knew. What an amazing opportunity it gives to people, to see what they really are. The level of health education in this country is generally so low, that it becomes hard for people to understand how to take care of their own health, how to follow the doctor’s orders, and why they should do this, or take that medication. The part I especially enjoyed, and thought was the most important, was seeing normal anatomical structures, as well as diseased ones, such as a smoker’s lungs, an enlarged heart from someone with congestive heart failure, an aortic aneurysm, an alcoholic’s liver, etc.

And while I am on the subject of Body Worlds, I wanted to comment on the sad state of our society. At the close of the exhibit, Body Worlds stayed open all night long to accommodate all the people that wanted to see it. Someone or some people, apparently not happy with one of the displays, decided to steal it in the middle of the night. http://cbs2.com/localnews/localnewsla_story_088193858.html It was a plastinated 13-week old fetus. Regardless of your views on any subject, you cannot make a moral statement through immorality. This is the first ever theft of a Body Worlds exhibit, which has been seen by millions of people worldwide. I am embarrassed for the people of our country.

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